Requestor Information - please provide the following information about yourself

Name
Department
Building
Room
Phone
E-mail

        Primary User Information - please provide the following information about the primary user of the printer

Name
Department
Building
Room
Phone
E-mail

        Printer Information - please provide the following information about the printer

Printer Model (Ex: HP LaserJet 4+)

Can this printer print on both sides of a sheet of paper (duplex)?
No    Yes

Would you like a banner page to print before each job?
No    Yes

Will you be printing reports from the Student Information System? ( TECHSIS )
No    Yes

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Complete the blanks below if your printer is connected directly to the network:

Printer IP Address	*static IP address can be obtained from NSC or NSS
Network Card Type	None HP JetDirect Token Ring HP JetDirect Ethernet LexMark MarkNet Token Ring IBM Token Ring Other If other, please specify

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Complete the blanks below if your printer is connected directly to a networked PC:

IP Address of PC	*static IP address can be obtained from NSC or NSS
LPD Software Installed on PC	None NIPrint RPM OS/2 LPD Other If other, please specify
LPD Queue Name

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